Blanchette v AAI Limited t/as GIO [2022] Nswpicmp
[2022] NSWPICMP 304
•27 July 2022
| DETERMINATION OF REVIEW PANEL | |
| CITATION: | Blanchette v AAI Limited t/as GIO [2022] NSWPICMP [2022] NSWPICMP 304 |
| CLAIMANT: | Christian Blanchette |
| INSURER: | AAI Limited t/as GIO |
| REVIEW PANEL: | Member Josephine Bamber Medical Assessor Tom Newlyn Medical Assessor Sharon Reutens |
| DATE OF DECISION: | 27 July 2022 |
| CATCHWORDS: | MOTOR ACCIDENTS – Review of Medical Assessment under Motor Accident Compensation Act 1999; dispute as to the degree of permanent impairment as a result of injuries sustained in motor accident on 23 May 2017; Held — original Medical Assessor’s Certificate confirmed; finding that major depressive disorder had resolved, and the residual features of anxiety do not fulfil the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for a psychiatric condition; the degree of permanent impairment is not greater than 10%. |
DETERMINATIONS MADE: | Issued under Part 3.4 of the Motor Accidents Compensation Act 1999 following a review under section 63 as to whether the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident is greater than 10%. The assessment made by the review panel under section 63(4) is as follows: The Panel confirms the certificate dated 15 March 2021 which certified that the psychological injury suffered by Mr Blanchette as a result of the motor vehicle upon 23 May 2017 had resolved. Therefore, the degree of permanent impairment is not greater than 10%. |
BACKGROUND
Mr Christian Blanchette suffered injury riding a Harley Davidson motor bike home from his work on 23 May 2017 when a Jeep Wrangler SUV collided with the right side of his motor bike. He sustained physical injuries including a fracture to his right ankle and right knee injury. He attended Camden Hospital and was transferred via ambulance to Campbelltown Hospital where he underwent surgery on 27 May 2017 by Dr Nouh involving an open reduction and internal fixation of his fractured medical malleolus. He also alleges he sustained a psychological injury as a result of the accident.
AAI Limited t/as GIO (the insurer) insured the owner and/or driver of the other motor vehicle for liability to pay Mr Blanchette any damages to which he may be entitled under the Motor Accidents Compensation Act 1999 (the MAC Act).
The parties are in dispute as to whether the degree of permanent impairment as a result of the injury caused by the motor accident is greater than 10%. This constitutes a medical dispute within the meaning of the MAC Act.[1]
[1] See s 58(1)(d) of the MAC Act.
The degree of permanent impairment is determined by making an assessment pursuant to Motor Accident Permanent Impairment Guidelines- Version 1, effective from 1 June 2018 (the Guidelines)[2]. The Guidelines are based upon the American Medical Association Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4). However, where there is any difference between AMA 4 and the Guidelines, the Guidelines are definitive.[3]
[2] Issued pursuant to s 44(1)(c) of the MAC Act and see s 133 of the MAC Act.
[3] Clause 1.2 of the Guidelines.
By letter dated 26 May 2020 Mr Blanchette’s solicitors filed his Application for Assessment of a Permanent Impairment Dispute by the Medical Assessment Service (MAS). He sought assessment of injuries to his “right ankle, right knee, right wrist, right elbow, TEMPSKI scarring and psychological sequelae”.
On 1 March 2021 the Personal Injury Commission (the Commission) commenced and now has jurisdiction in relation to Mr Blanchette’s Application. Medical Assessor Samuell in his certificate dated 15 March 2021 found Mr Blanchette sustained injury caused by the motor accident on 23 May 2017 in the form of major depression, however, that injury had resolved and did not result in permanent impairment.
Mr Blanchette filed an Application for Review of Medical Assessor Samuell’s certificate pursuant to s 63 of the MAC Act relying on submissions dated 11 May 2021.
The insurer filed its response with submissions dated 18 June 2021.
On 21 July 2021, the delegate of the President issued her decision that there would be a referral of the medical assessment to a Review Panel (the Panel) as she was satisfied that there was reasonable cause to suspect that the medical assessment was incorrect in a material respect having regard to the particulars set out in the application.[4]
[4] Section 63(2B) of the MAC Act.
Pursuant to s 63(3) of the MAC Act and Schedule 1, cl 14F(2) of the Personal Injury Act 2020 (the PIC Act), the Panel consists of two Medical Assessors and a Member of the Motor Accidents Division of the Commission.
CONDUCT OF THE REVIEW
Part 5 of the PIC Act enables the Commission to make rules with respect to the practice and procedure before the Commission including proceedings before a panel reviewing a decision of a Medical Assessor.[5]
[5] Section 41(2) of the PIC Act.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A review panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[6]
[6] Rule 128 of the PIC Rules.
On 25 November 2021 the Panel issued a Direction to the parties requiring them to each file an indexed, paginated bundle of documents that they wished to rely upon in relation to the review.
On 22 December 2021 the Panel issued a further Direction to the parties to advise them it had conducted a preliminary review of the matter on 10 December 2021 and the Panel considered a re-examination of Mr Blanchette was required. An appointment was arranged for 4 February 2022 but that did not take place. The examination was conducted on
1 July 2022 by both Medical Assessors Newlyn and Reutens by an audio-visual consultation.The Direction dated 22 December 2021 included the following directions:
“4. The Panel requests the claimant obtain the following documents, serving a copy on the insurer, and file in the Commission an indexed, paginated copy of the documents on or before 21 January 2022:
a.Updated records from the claimant’s treating general practitioner.
b.Records from treating psychologists for pre and post the motor accident on 23 May 2017.
c.Copies of any treating psychiatrist reports for pre and post the motor accident on 23 May 2017.
d.Records from the Pharmaceutical Benefits Scheme to ascertain the medication prescribed for the claimant pre and post the motor accident on 23 May 2017.
5. Should the claimant seek to make submissions in relation to these records he is to do so on or before 21 January 2022.
6. The insurer is to make any further submissions on or before 28 January 2022.”
On 21 February 2022 the claimant filed a bundle of documents[7] attaching clinical records of Dr Benedict Chua as at 20 May 2020, clinical records of UR Family Practice, clinical records of Camden Healthcare Centre and report of Dr Richa Rastogi dated 11 May 2020.
[7] AD1.
At the same time records were filed from Services Australia with their covering letter dated 29 July 2020[8], and Medicare Patient History Report for the period 28 October 2012 to 28 October 2021[9].
[8] AD2.
[9] AD3.
On 30 March 2022 the insurer filed an indexed bundle of documents attaching:
a. email correspondence from the claimant’s lawyers dated 18 February 2022 about the treating doctors consulted by the claimant;
b. the contents of subpoena packet 9 from Services Australia produced in District Court proceedings 2019/00380289 containing:
i.Medicare Patient History Report for the period 1 February 1984 to
25 June 2020[10],[10] AD4 pp 14-23.
ii.Notice of Past Benefits Charge dated 13 February 2019[11], and
[11] AD4 p 24.
iii.Individual Prescribing History for period 1 January 1991 to
25 June 2020[12];c. the contents of subpoena packet 21 from Our Home Medical, Gregory Hills, produced in District Court proceedings 2019/00380289 containing the Patient Health Summary[13], and
d. the contents of subpoena packet 26 from Services Australia produced in District Court proceedings 2019/00380289 containing:
i.Medicare Patient History Report for the period 28 October 2021 to
11 February 2022[14], andii.PBS Patient Summary dated 21 February 2022[15].
[12] AD4 p 26.
[13] AD4 pp 53-66.
[14] AD4 pp75- 80.
[15] AD4 p 81.
No further submissions were filed by either party.
SUBMISSIONS
The claimant did not include in its MAS application any submissions. It attached the following documents to that application:
a. A1: letter to insurer dated 18 November 2019 serving Dr Dias report;
b. A2: clinical records of Schwarz Family Practice;
c. A3: discharge summary of Campbelltown Hospital;
d. A4: reports of Dr Fred Nouh;
e. A5: X-rays of the right ankle dated 6 June 2017;
f. A6: X-rays of the right fibula and right ankle dated 26 July 2017, and
g. A7: report of Dr Dias dated 6 November 2019.
The claimant’s submissions dated 11 May 2021 were provided in relation to his application for review of the certificate of Assessor Samuell. It is submitted that Assessor Samuell erred due to failure to consider the criteria for diagnosis of psychological conditions, the report seems incomplete, and his path of reasoning cannot be followed. It is further argued that if there is a finding that there was a resolution of symptoms, there needed to be a history of a change in symptoms and at the very least a re-consideration of the DSM-IV criteria. It is argued that from the description of ongoing symptoms, such as sleep disturbance, weight gain, diminished interest and pleasure, loss of energy and feelings of worthlessness a diagnosis should have been made of an ongoing psychological condition such as minor depression or an adjustment disorder.
The Panel advises that its assessment is a fresh assessment and is not restricted to identifying error in the certificate and reasons issued by Assessor Samuell.
The insurer provided undated submissions with its MAS reply which are mainly concerned with the physical injuries suffered by the claimant in the accident on 23 May 2017. In relation to the psychological injury, the insurer submitted that the claimant had not served any medical evidence in support of the alleged psychological injuries being over the threshold. It argues that there is no dispute as to the alleged psychological injuries at that stage and should MAS exercise its discretion to refer the psychological injuries for assessment the insurer reserves the right to make further submissions.
In the insurer’s submissions dated 18 June 2021 in response to the claimant’s application for review, the insurer draws attention to paragraph 1.23 of the Guidelines that an Assessor should only consider the impairment as it is at the time of his/her assessment. The insurer argues that symptoms are apt to change at various times. It submits it was open for
Assessor Samuell to conclude the claimant no longer suffered from the symptomology previously described to other experts.The insurer argues that Assessor Samuell provides a thorough and comprehensive history of the claimant's condition noting that:
(a) he was an unshaven, overweight man wearing work clothing at the time of the assessment;
(b) his level of self-care and grooming appeared to be reasonable;
(c) he presented as an authentic-sounding examinee;
(d) his psychomotor functioning was normal;
(e) he was not observed to be distressed or disordered at any stage of the assessment;
(f) his speech was normal;
(g) he did not describe prominent symptoms of a psychological nature;
(h) no cognitive distortions were identified;
(i) his affect was reactive and observed within normal range;
(j) he did not look depressed or anxious;
(k) his cognitive functioning was clinically normal;
(l) there was no evidence of psychosis;
(m) he is presently working with no psychological restrictions;
(n) he is working full time basis;
(o) he has excellent relationship with his wife and daughters;
(p) he is able to attend all activities of daily living without any psychological restrictions;
(q) he showers twice daily, and
(r) he is perhaps socialising less than he used, but for reasons that were not relevant to his mental health.
The insurer argues it was open for Assessor Samuell to make the findings expressed in his certificate. It also challenges the submission that the reasons of Assessor Samuell were incomplete because even though point 15 was not filled out, earlier in his reasons he did deal with the documents before him.
SUMMARY OF DOCUMENTATION
In addition to the documents referred to above that were attached to the original MAS application, it appears further documents were filed which Assessor Samuell refers to at point 4 of his reasons, A7 to A12.
A7 contains records from Optimal Health Medical Centre for one consultation on
21 June 2020 in relation to a covid test.A8 contains brief records from Harrington Park Medical Practice in relation to consultations on 7 March 2014, 15 March 2014 and 3 December 2020. However, the only treatment detail relates to an immunisation with Vaxigrip.
A9 contains records from Waverley Medical Centre with a consultation on 17 May 2018 when eye drops were prescribed. The patient registration form has a dash beside the question “are you on any medication?”.
A10 are records from Primary Medical Centre Narellan with one entry on 11 November 2018 when a Dr Satpal Chaudhri prescribed Lovan for anxiety/depression and there is a note “ran out of medication, working well, counselled to continue”.
A11 contains records from Camden Healthcare Centre. There is one entry on 15 April 2018 “attended for Lovan. On it on and off for few years since one of his friends had a tragic death, levels his mood, very happy with the pill. Mood has been ok. No DSH/suicidal thoughts, well otherwise”.
A12 are records from UR Family Practice dealing with one consultation on 6 February 2017 with Dr Yu Zhang. It is recorded that the claimant had an eight year history of depression and anxiety and has been on citalopram for years with some effect. It was noted that his mood was ok, he denied suicidal ideation and he has had counselling in past for relation difficulties. He had one panic attack two years earlier. It is noted that his father had a history of anxiety/depression.
It appears the original reply attached as R2 the clinical notes of Dr Chua. Most of these records are not relevant to the psychological injury claim. The Discharge Summary and Operation Report from the Campbelltown Hospital relating to the accident on 23 May 2017 and included in these documents. The handwritten clinical entries are difficult to read.
R3 is a report of Dr John Ashwell dated 7 February 2020, which only deals with his physical injuries.
Additional documents appear to have been filed marked as:
a. AD1-R4 from Schwarz Family Practice. These records include clinical consultation notes which refer to psychological conditions. For instance, on
12 March 2018 the claimant was diagnosed with depression, and it was recorded he had been on Prozac for a long time but had been changed to Zoloft, which he felt was not right for him. The doctor prescribed Prozac and noted his mood was stable. On 14 September 2018 it was noted the Prozac had made a huge difference for him and a further prescription for it was issued. A further script was issued on 17 August 2019;b. AD2- R5 records from Dr Fred Nouh. Dr Nouh is the orthopaedic surgeon who performed the open reduction and internal fixation surgery to the medial malleolar fracture sustained in the motor accident on 23 May 2017, and
c. AD3- R6 records from Dr Chua- these substantially appear to be duplicates of R2.
AD4-R7 contains records from Nissan Australia (177 pages of employment records) and AD5-R8 GIO workers compensation file relating to a right knee injury on 14 January 2015 (157 pages).
The Our Medical Home Gregory Hills records contain the following relevant entries:
a. 22 April 2002 diagnosis of depression and Lovan 20mg prescribed;
b. 9 December 2014 Lovan 20mg and Celapram 20mg were prescribed;
c. 6 March 2012 reason for contact noted as “depression”. Lexapro 10mg prescribed;
d. 19 March 2012 the dosage of Lexapro was increased to 20mg;
e. 28 May 2012 Lexapro 20mg prescribed;
f. 23 May 2014 depression diagnosed and noted claimant gets anxious, reference to work stresses with people being made redundant and also he has a new baby, four months old. Citalopram 20mg was prescribed;
g. 18 August 2014 it was noted the claimant was feeling better with Citalopram and that he had been busy at work and missed a few days of it and could feel himself slipping, and
h. 14 December 2015 it is noted he stopped Celapram after six months from the last visit and it was prescribed again.
The PBS records show the past dispensing of prescriptions since 9 November 2012 including for Escitalopram, Citalopram, Temazepam (once) and from 12 March 2018 for Fluoxetine. The last record of fluoxetine is the prescription dated 30 July 2021 with supply date 24 November 2021. This PBS report is dated 21 February 2022[16].
[16] AD4 p 81.
Dr Rastogi
Dr Rastogi, psychiatrist, provided a medico-legal report for the claimant dated 11 May 2020. The doctor diagnosed major depression disorder with anxiety and chronic pain disorder. The Panel notes that Dr Rastogi did not have a history of the claimant’s pre accident psychological history and treatment and the doctor states, “There is no known previous history of mood disorder or any treatment received”. Dr Rastogi finds,
“Mr Blanchette presents with anxiety characterised by arousal, avoidance, poor stress coping, ruminations, being retriggered, sleep disturbances and excessive fears impacting his function. He reports persistent depressive symptoms characterised by disappointment, anhedonia, worthlessness, negative cognitions, and lack of adaptation with poor stress coping. He feels defeated and disappointed and is emotionally detached from children. The presence of chronic pain with limited functioning is perpetuating depression and chronic sense of feeling overwhelmed.
He is stuck with fear, disappointment, and pessimism about the future. He holds a guarded prognosis for the future in terms of his ability to do premorbid duties and likely the pain will aggravate causing functional impediments.”
Dr Rastogi assessed the claimant as having 11% whole person impairment.
RE-EXAMINATION
The following examination report has been prepared by the Panel, taking into account the clinical findings of the Panel’s Medical Assessors, and the history taken from Mr Blanchette in the examination:
Introduction
Mr Blanchette is a 43 year-old man who lives with his wife and their three daughters aged 19, 14 and 9. His wife is the deputy principal of a primary school. Mr Blanchette is a manager for a construction company that installs electrical installations in commercial building sites.
Medical history
Mr Blanchette had a right knee arthroscopy for a tear of the medial meniscus in 2015. The records indicate that he had a history of right shoulder dislocation. He said he was otherwise healthy.
Pre-accident psychiatric history
Approximately 15 years ago Mr Blanchette was snowboarding with his brother and their friend when their friend did not return. They looked for him for three days, eventually finding him deceased. He stated the event “rocked me”. For the next six to eight months he experienced recurring thoughts of that event, which distracted him at work and he avoided snowboarding for the next three or four years. He was prescribed antidepressant medication by his general practitioner (GP) and continued to take it over the years because it would “smooth my mood”. Mr Blanchette described unimpeded functioning, being able to work and socialise. He denied symptoms of depression, panic attacks and had never been suicidal. There was no history of hypomania, manic symptoms, features of obsessive-compulsive disorder or psychosis.
Mr Blanchette attended family therapy but had never had individual psychotherapy.
Substance use history
Mr Blanchette stated that he did not drink or smoke cigarettes. He did not use illicit drugs.
Family psychiatric history
His father had a history of post-traumatic stress disorder having fought in the Vietnam War and his work as a police officer, needing an admission to St John of God hospital in the last three or four years.
Forensic history
Mr Blanchette was handed a good behaviour bond for assault after the subject motor vehicle accident.
He submitted a workers compensation claim for the 2015 knee injury.
Personal history
Mr Blanchette was raised in Camden, the fifth of a family of nine with six boys and three girls. His father worked shifts as a police officer but still had time to attend Mr Blanchette’s sports games. His mother initially worked in a bank then studied law, becoming a barrister.
Mr Blanchette stated that he and his siblings looked after each other but did not describe feeling parentified and stated that he felt that he had support, love and attention from both parents. He denied a history of any traumatic events during his developmental years.He schooled at St Paul’s Primary School and attended St Gregory’s College for high school until Year 10, moving to a co-ed school for Years 11 and 12. He could manage academically and socially and did not describe any behavioural problems.
After completing Year 12 Mr Blanchette embarked on a mechanic apprenticeship and completed the small motors component but left when he was offered to join his wife’s father’s business. He subsequently completed several courses of study, including a diploma in business administration and a marketing course. At one stage he was enrolled to study for an MBA but stopped because he changed jobs.
Mr Blanchette described a stable marital relationship that had not been marred by any abuse or separations. His three daughters were healthy.
Pre-accident functioning
Mr Blanchette enjoyed riding and working with motorbikes. He had worked in corporate roles for three motorbike manufacturers: Kawasaki, Yamaha and Harley Davidson. At the time of the accident, he was working for Harley Davidson, overseeing a conglomerate of Harley Davidson dealerships in NSW and developing two new dealerships in Sydney. His role involved establishing and maintaining business relationships, attending internal and client meetings, and travelling to the different dealerships.
He and his wife shared the housework and parenting duties. There were no difficulties in managing his personal hygiene and self-care. Mr Blanchette went to the gym regularly and enjoyed sports such as dirt bike riding, snowboarding and skateboarding. He was part of a social network of motorbike riders and went snowboarding with his friends. He was classically trained in the guitar and liked to write and play music.
He had good relationships with his family members, his siblings and parents.
History of the motor accident
The accident occurred about 300 m from Mr Blanchette’s house when he was riding home on his motorbike. Mr Blanchette was in the right lane waiting to turn right. The traffic in the left lane was flowing. A female driver in the car behind him drove to his side and hit his shoulder and right leg. His right ankle was caught on the foot peg but he could stay upright. He stated that “it felt like she was climbing on top of me”.
He stated that he lay down because he was feeling sick and his foot was painful.
Mr Blanchette could exchange details with the other driver and ride his motorbike home, not realising that his foot was broken. Police and ambulance did not attend the scene.
History of symptoms and treatment following the motor accident
Mr Blanchette’s wife drove him to Camden Hospital and he was transferred to Campbelltown Hospital. The documents indicate that he sustained a right medial malleolus fracture, a right proximal tibia fracture, and a tear of his right anterior cruciate ligament. After surgical treatment of his injuries, including internal fixation, he was discharged home wearing a moon boot and using crutches to mobilise.
Mr Blanchette took two or three days off work then a colleague drove him to and from work because he could not drive because of his physical injuries. He consulted a physiotherapist who taught him strengthening exercises but continued to experience discomfort and limited mobility in the ankle that prevented him from engaging in the sports he used to enjoy.
Mr Blanchette first noticed emotional symptoms when the moon boot was removed, approximately eight weeks after the motor accident. He realised that he had lost interest in motorbikes and considered them dangerous. At work, he felt guilty whenever a salesman sold a motorbike. He no longer trusted car drivers and was anxious when travelling near motorbikes. His mood became depressed.
He had a sense of resentment about the accident because “I didn’t ask for this”.
Mr Blanchette explained that he was in pain and had to deal with insurance companies and subsequently with independent medical examiners through no fault of his own. His threshold for irritability was low and he felt the loss of not being able to undertake sports and activities he previously enjoyed. He resigned from work approximately eight months after the accident, saying he had “had enough”. Mr Blanchette stated his interpersonal performance was deteriorating and he had also lost the thrill of being around motorbikes.He took three months off work after resigning and then decided to work in the car industry, although without the passion that accompanied his role in the motorcycle industry. He worked for the Nissan motor company in a corporate role, stating the processes were like the motorbike industry. He was initially energised to undertake his role and said his performance was “okay”, saying that he had only missed his monthly targets on one occasion and received very positive reviews. During COVID he took voluntary redundancy and was re-evaluating where he would work. After three weeks he started getting bored and ran into an old friend who was just starting up an electrical installation company and offered him a role. He stated that he loved it compared to the corporate life. He got on well with the high-end tier one builders and also enjoyed working with the tradespeople.
When asked about the treatment of his low mood, Mr Blanchette stated that he consulted his GP, Dr Chua. He was not on an antidepressant at the time of the accident and Dr Chua commenced him on an SSRI antidepressant medication and referred Mr Blanchette to a psychologist but Mr Blanchette stated that he did not attend having decided he would wait to see if the antidepressant medication worked.
Current symptoms
Mr Blanchette stated that his mood was up and down but stated it was within relatively normal parameters. He still felt a sense of resentment for being unable to undertake activities through no fault of his own.
He described a tendency to “zone out”, which started after the accident. This occurred during conversations, particularly with people that he did not trust. He said it felt as if he was not really there. This sense of dissociation had improved over the years.
He stated that he continued to be reminded of the accident if he drove past the site but did not avoid it. He experienced panic attacks after the accident “a couple of times” consisting of hyperventilation and anxiety that lasted for about 10 or 20 minutes. After his first panic attack he thought he was having a heart attack. He stated that he did not like being around people such as in crowded places, and whereas he previously could go to shopping centres he now tended to avoid them and no longer wanted to attend music festivals because of the crowds. He stated that he did not trust people as much and in the initial aftermath was very protective of his children, telling them, “don’t go there you’ll hurt yourself”. This had lessened over the years.
He continued to have a lower threshold for irritation. Mr Blanchette gave an example whereby if he was disagreeing with his 19 year-old his wife would calm him down and remind him to “take a breather”. He stated that this had not been necessary before the accident.
He had not had nightmares of the accident and stated he could not recall the last time he dreamed at all. He currently sleeps for about 5-6 hours a night, referring to having to wake up at 4 am in his current role. He might wake up once or twice during the night and occasionally found it difficult to return to sleep because of “thoughts running around” but stated these were various thoughts and not necessarily negative or of the accident. He was generally eating regularly but his weight had increased since the accident because his ankle rendered him unable to undertake exercise.
Mr Blanchette stopped taking the antidepressant medication in around December 2021. He stated that his wife mentioned that he had 4-6 weeks of mood swings, but he had not noticed any enduring changes in his mood and did not mention any changes in his anxiety levels. He was not taking any other medication.
Current functioning
Mr Blanchette shared household duties with his family. At one stage his wife had to take over much of the heavy gardening duties such as lawn mowing after the accident, but he was now more physically capable of undertaking these roles. He still experienced pain when walking particularly if he was walking on stairs or on an incline. He stated that he contributed to the cooking and the internal housework and was generally eating three meals.
He could not run, ride a pushbike or motor bike, snowboard or skateboard because of his ankle injury and was not undertaking any exercise. He continued to undertake his parenting duties and watched his daughters play netball.
Mr Blanchette stated that he enjoyed and could be immersed in his music. He continued to play guitar and write music. He was a member of a band and sometimes met up with the band members, but because they were all busy, they tended to record their parts separately. He could go out independently but had still not resumed socialising to the extent that he had before the accident. This was partly because he was physically unable to take part in his previous recreational activities such as snowboarding and could not attend these trips with his friends. He had last gone out approximately one month before this appointment with his family members. He and his wife sometimes went to the movies or for a meal.
Mr Blanchette could drive without any psychiatric barriers. He could not ride a motorbike because the rear brake was operated by the right foot and said he would not ride anyway as he had lost interest in it, no longer trusted drivers and thought motorbike riding was dangerous.
His family were supportive. He stated that his injury and mood had affected the family soon after the accident, but they had “now worked through it” and he had good relationships with all family members, his siblings and his parents.
He could concentrate on writing music and his work. His wife did most of the daily financial duties but given his previous corporate role and because he was used to reading contracts, he undertook the work if there were any major financial commitments.
Mental state examination
Mr Blanchette was punctual for the interview and was neatly groomed. He appeared to be making eye contact with the assessors’ image on the screen. His mood was judged to be euthymic, and although anxious, as suited the nature of the interview, he could form a rapport. Nonetheless, he remained somewhat wary and nervous for its duration. He did not display any psychomotor agitation or retardation or any noticeable neurological signs. He provided his history straightforwardly without seeming to embellish, and elaborated at points in the interview, speaking with average rate, rhythm and prosody. There was no evidence of any psychotic phenomena, nor did he appear to be dissociating through the interview. He maintained satisfactory focus during the interview. The main themes were of his sense of having to adjust to the losses wrought by his injuries and a lingering sense of resentment and anxiety. He denied thoughts of harm to himself and did not describe thoughts of harm to others. Mr Blanchette had insight into his condition and his judgement was appropriate at the time of the interview.
Diagnosis
Major depressive disorder with anxious distress in remission.
Opinion
Mr Blanchette is a 43 year-old father of three children who reports a motorbike accident in 2017 that resulted in right lower limb injuries, the effects of which persist in the form of pain and reduction in mobility. A previously active man he has had to abandon some of his previous recreational pursuits. From a psychiatric perspective, he developed symptoms of a major depressive disorder characterised by low mood, disinterest in activities, withdrawal, irritability and decreased motivation. Anxiety symptoms took the form of irritability, avoidance of riding motorbikes and a sense they were dangerous. He became more protective and anxious about his children’s welfare, experienced several panic attacks and continued to avoid crowded areas because they triggered anxiety.
Mr Blanchette’s emotional symptoms occur on the background of low levels of anxiety that are likely residual features of post-traumatic stress disorder that developed after his friend’s death about 15 years ago. Symptoms of the post-traumatic stress disorder that have since resolved included intrusive thoughts, avoidance of reminders of the incident such as avoiding snowboarding, hyperarousal in the form of anxiety and concentration impairment. Although the symptoms remitted, he continued to take antidepressant medication for what sounded like persistent mild symptoms of anxiety that did not interfere with his functioning.
Mr Blanchette described superior emotional resilience in the aftermath of the subject accident. He described symptoms of major depression but has been able to gradually adjust to his losses to the point that most of his symptoms have resolved or do not interfere with his functioning. He described good relationships with his family and is currently enjoying work on a full time basis. While residual features of anxiety do not interfere with his day-to-day functioning, he would not fulfil DSM-5 criteria for a psychiatric condition. He no longer takes antidepressant medication and continues to function at a superior level. Thus, the Panel decided the major depressive disorder has resolved.
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